Carl Erik Mabeck

Use of antibiotics in general practice in Denmark in 1987

The worldwide usage of antibiotics is increasing making detailed information on prescribing patterns and intervention methods necessary. This investigation focused on the general practitioners (GPs) usage of antibiotics in Denmark. Information on 7,607 patients treated by 602 GPs during 1 week in March 1987 were collected. The most commonly treated infectious diseases were upper respiratory tract infections (40%) and lower respiratory tract infections (17%). Penicillin was by far the most frequently prescribed antibiotic (44%), followed by antibiotics used locally (17%) and ampicillins (14%). Compared with previous investigations, this result indicated a relative increase in prescription of penicillin during recent years. The mean number of daily dosages was 2-3 and the duration of treatment 6-7 days, with ampicillin generally given 1 day longer than penicillin. The differences between prescribed daily dosages (PDD) found and defined daily dosages (DDD) ranged from + 40% to - 50%, making estimations of numbers of treated patients from total usage of antibiotics in DDD/1,000 inhabitants/day impossible.

Is Variation a Quality in General Practice

health care system is characterized by payment systems, capacity, access to medical care, equipment, referral structures, etc. Factors related to the organization of the practice include list size, ancillary staff, practice facilities, practice form, equipment, etc; while. doctor-related factors include, for example, sex, age, differences in professional skills and knowledge, and factors related to the GP’s personality and attitudes. In this article special emphasis is put on studies concerned with the effects of general practitioners’ attitudes to medical decisions.

The effect of reimbursement on the use of antibiotics.

OBJECTIVE To examine the effect of a reduction on the reimbursement of drugs on the use of antibiotics by general practitioners in Denmark. DESIGN A prospective study using a questionnaire comparing the results with a similar study 3 years before, a period with normal reimbursement. PARTICIPANTS 553 general practitioners prescribed antibiotics for 5765 patients. MAIN OUTCOME MEASURE Number of treated patients and choice of antibiotics. RESULTS 7607 patients were treated in 1987 compared with 5765 in 1990, the relative number of patients treated for sinusitis, other upper respiratory tract infections, acute bronchitis, pneumonia and upper gynaecological infections was significantly less in 1990 than in 1987. Other infections, particularly those that are often diagnosed by culture or microscopy by the general practitioners themselves, increased significantly. They included tonsillitis and urinary tract infections. CONCLUSION Reimbursement can be a very powerful tool controlling the use of antibiotics by general practitioners.

Use of antibiotics in general practice in Denmark. Prescribed daily dose, duration of treatment and number of treatments in general practice.

Prescribed daily dose (PDD) and duration of treatment is estimated for the most commonly used antibiotics in a multipractice study. In 1979 574 general practitioners and in 1983 625 general practitioners recorded 7 681 respectively 8 182 prescriptions of antibiotics over a five-day period. PDD and the number of treatments were compared with Defined Daily Dose (DDD) and DDD/1 000 inhabitants/day from the official statistics of drug consumption. It was found that these commonly used units were rather misleading with regard to the daily dose actually prescribed and the number of treatments given in a certain period.

Referral from General Practice to Dermatologists

There are many unexplained differences in the rates at which general practitioners make referrals to other medical specialists. We investigated 5,082 referrals from 141 general practitioners to dermatologists in Ringkøbing county in Denmark. As an expression of the referral rate to dermatologists an index of referral to dermatologists was estimated for every general practitioner. The index of referral to dermatologists was the number of referrals to the dermatologists per 1,000 patients per year, including children, standardized for age and sex to the average population in Ringkøbing County. The following six variables were evaluated in relation to the referral index: 1) Distance to the dermatologists, 2) number of doctors per practice, 3) number of consultations per general practitioner per year, 4) number of patients registered, 5) number of consultations per 1,000 patients per year standardized for age and sex, and 6) number of supplementary procedures per consultation. Stepwise multiple linear regression analysis was used. The study showed that the referral index to dermatologists fell both with distance to the dermatologist and with the number of supplementary procedures per consultation. No correlation was found between the referral index and the four other variables studied.

Prescribed Daily Dose of Phenoxymethylpenicillin in General Practice

Prescribed daily dose (PDD) of phenoxymethylpenicillin was estimated in a multipractice study in 1979 and in 1983. PDD increased from 2.08 mio IU in 1979 to 2.32 mio IU in 1983. PDD was independent of number of daily doses, and factors related to practice. Only slight variations with diagnosis and doctors age was found.

Prescription of Antibacterial Drugs for Treatment of Bronchitis and Pneumonia in General Practice in Denmark

Phenoxymethyl penicillin is the drug of choice in the treatment of acute respiratory tract infection. The widespread use of a broadspectrum antibiotic indicates that practitioners use such a preparation in the absence of a proper microbiological diagnosis. A relatively high proportion of patients were treated with erythromycin. This may reflect the widespread misconception of allergy to penicillin among patients and doctors. Too many prescriptions for antibacterial drugs seem to be based on telephone contact.